Objective:

To exemplify an unusual presentation of Takayasu arteritis

Background:

Takayasu arteritis is a systemic inflammatory condition which leads to stenosis of medium and large arteries, predominantly in young Asian women. 

Design/Methods:

NA

Results:

A 54 year-old Polish speaking male with history of tobacco use, hypertension, and prediabetes presented to the emergency department with acute onset left hemiplegia. CT head showed right MCA infarct with petechial hemorrhagic conversion. CTA head/neck showed right M1 occlusion in setting of multi-focal ICAD and chronic left MCA infarct. He was outside the window for acute intervention. Neurologic exam showed aphasia, left sided hemiplegia, and sensory loss. MRI brain confirmed an acute right MCA infarct with hemorrhagic conversion. He was started on empiric dual antiplatelet therapy for ICAD, but also 14-days of empiric acyclovir for suspected VZV meningoencephalitis. However, CSF PCR and antibodies were negative. He was ultimately discharged to acute rehab and lost his pulses there. Medicine and rheumatology consulted at this time with recommendation of CT imaging. CT chest/abdomen/pelvis with intravenous and oral contrast showed severe stenosis of right brachiocephalic artery, occlusion of the right subclavian artery, right carotid with severe multifocal stenosis, left subclavian artery complete occlusion, severe stenosis of the celiac artery, SMA minimal focal stenosis, bilateral renal artery mild focal stenosis and bilateral common iliac artery severe stenosis. ESR and CRP initially high at admission, but normal the time of diagnosis. Diagnosis of Takayasu arteritis was made based on the distribution of affected vessels. Patient subsequently started on monthly tocilizumab infusions due to high risk of progression.

Conclusions:

This case exemplifies a presentation of Takayasu arteritis resulting in ischemic stroke in a patient who does not fit the typical demographic for this disease.